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Measurement & Evaluation Center
University of Houston
Course Exam Score Request Form
4365 Wheeler St, 206 Student Svc Ctr 1, Houston, TX 77204-3054
713.743.5440 - 713.743.5442
www.uh.edu/mec
Type of Answer Sheet:
Blue
Green
Purple
Scantron 882-E
Other:_________________
INSTRUCTOR/COURSE INFORMATION
Date
Course Title & Number (e.g. PSYC 1300)
Instructor
Class Numbers (5 digit valid class number required)
Department
Building/Room #
Phone Number
E-mail Address
Number of Keys
Test Number
PERSONS AUTHORIZED TO RECEIVE SCORES
Please list T.A.s or other persons authorized to receive these scores:
SCORING SERVICES
SCORING FORMULA (CHECK ONE ONLY)
Name and ID Roster (Student Score Report)
Score = # (Correct Items)
Score Distribution
Score = # (Correct Items)
# (Incorrect Items)
Simplified Item Analysis
Score = # (Correct Items)
Student Response Report (SRR)
Score = # (Correct Items)
Multiple Answers per item (raw data file (.dat) only)
Score = # (Correct Items)
1 # (Incorrect Items)
2
1 # (Incorrect Items)
3
1
# (Incorrect Items)
4
Scoring only (No report)
WebCT conversion to disk
E-mail Scores to
Scan to:
We can ONLY send scores to UH Email Address
USB
Must provide your own device.
USB will be formatted to prevent viruses
SPECIAL INSTRUCTIONS
PRIVACY NOTICES ON UNIVERSITY FORMS
"State law requires that you be informed of the following:
(1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form;
(2) under sections 552.021 and 552.023 of the Government Code, you are entitled to receive and review the information; and
(3) under sections 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect."
If you do not want to wait and prefer to drop off your answer sheets, please pick up the answer sheets within ONE WEEK of scoring.
Any answer sheets not picked up within one week of scoring will be returned via inter-office mail and you
WILL BE BILLED $5.00 per envelope through your academic department, unless an-inter office envelope or large envelope is provided.
We are not responsible for the loss of answer sheets sent via inter-office mail.
SUBMIT
RECEIVE
Your signature below certifies that the services requested are for
the course listed above.
Your signature below signifies that you have received all the test
materials submitted for scanning and scoring.
Name (Print)
Name (Print)
Signature
Date
File Name
Signature
OFFICE USE ONLY
Date
Number of records
Download forms and view our services at www.uh.edu/MEC.
O://MEC/Forms/Exam Scoring Request Form 010916
Revised: Spring 2016